Laserfiche WebLink
Q e 0S 4�+5 33 <br />SAN J OA Q U I N Environmental Health Department <br />C (_: U r\I _..� <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />CFO Business Name: n Owner Name* Date: <br />Kwwcaco6s <br />CFO Physical Address: CFO City. CFO Zip: <br />7539 Wim: c t -d C;r. VAOmeccX �5` �-7 <br />Website (If applicable): Telephone. <br />X09 - -85`39 <br />1. Categories: <br />Class A"Onl Sales Direct <br />( y) $155 ❑ "Class B" (Direct &Indirect Sales) $310 <br />2. Prohibited Items: Initial if you agree to abide by the following: AT <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. Only <br />foods that are defined as "non -potentially hazardous" are approved for preparation by a Cottage Food Operation. <br />These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a <br />cause of food-bome illness. <br />3. "Class A" Self Certification Checklist: <br />[A Checklist completed ("Class A" CFOs Only) <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br />N <br />Baked Goods <br />ElDried <br />Pasta <br />ElHoney <br />ElPopcorn/ <br />Popcorn Balls <br />❑ <br />Candy <br />❑ <br />Dry Baking Mixes <br />❑ <br />Mustard <br />❑ <br />Vinegar <br />❑ <br />Churros <br />❑ <br />Waffle Cones <br />❑ <br />Dried Grain Mixes <br />❑ <br />Fruit Butter" <br />®Buttercream <br />ButtercreamGround <br />❑ <br />Flat Icing <br />❑ <br />Frosting/Icing` <br />Fondant/Gumpaste' <br />Chocolate <br />❑ <br />Dried Mole Paste <br />❑ <br />Herb/Spice Blends <br />❑ <br />Pizzeles <br />❑ <br />Jams/Jellies`• <br />❑ <br />Fruit Empanadas <br />❑ <br />Fruit Tamales/Pies <br />❑ <br />Nut Mixes/Nut <br />El <br />Fried or Baked <br />and <br />Butters <br />Butters <br />Waffles <br />® <br />Granola/Cereals <br />❑ <br />Seasoning Salt <br />❑ <br />Trail Mix/ Dried Fruit <br />❑ <br />Dried Fruit <br />❑ <br />Cotton CandySalted <br />❑ <br />Candied Apples <br />❑ <br />❑ <br />Marshmallows/ <br />Marshmallow <br />CaramellFudge <br />Bars' <br />El <br />Dried or Dehydrated <br />El <br />Dried <br />Dried Vegetarian - <br />❑ <br />Vegetable and Potato <br />Chips <br />Vegetables <br />Soup Mixes <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />S <br />